Researchers project that some 13.2 million American adults 65 and older will have Alzheimer’s disease by 2050 unless new ways are found to treat the disease. According to these latest estimates from researchers at Rush-Presbyterian-St. Luke’s Medical Center in Chicago, the number of elderly people with Alzheimer’s disease—currently 4.5 million—will grow dramatically as the population ages, with the most notable increase in persons 85 and older. The estimates were derived from a study of Alzheimer’s disease incidence over four years among 3,913 Chicago residents 65 and older. National prevalence was calculated using census data and death rates from the National Center for Health Statistics. The results were published in the August Archives of Neurology.

A population-based study comparing pain in patients with multiple sclerosis (MS) to a reference group without MS found that the frequency of reported pain in patients with MS was not higher than that reported by the reference population. However, pain intensity, the need for analgesic treatment, and the impact of pain on daily life were all significantly higher for patients with MS. The study was conducted at the Danish Pain Research Center in Aarhus, Denmark, and based on the population of Aarhus. The results were published in the August Archives of Neurology.

Stroke survivors who received therapist-supervised, progressive therapy after completing in-hospital rehabilitation significantly improved their endurance, balance, and walking ability, according to a study reported in the August Stroke. The researchers noted that the study goes beyond the commonly held paradigm that stroke patients achieve their most dramatic recovery within the first 30 days after stroke, demonstrating that an aggressive home-based exercise program can improve walking ability, balance, and cardiovascular endurance. The investigators studied 92 stroke survivors (average age, 70) in the first four months after stroke. Those in the intervention group performed progressively intensive exercises in 36 supervised sessions. Compared to patients in the “usual care” group, who received no or limited physical therapy, the intervention group showed significant improvements at three-month follow-up in balance, mobility, and endurance, the researchers reported. Further investigation is warranted, they said—though they acknowledged that implementing such a program in communities would likely prove difficult.

Melatonin successfully alleviates many patients’ symptoms of REM-sleep behavior disorder, according to research published in the July Sleep Medicine. The Mayo Clinic study was conducted retrospectively with 15 patients treated with melatonin. All but one of the patients were male. All patients had a comorbid neurologic disorder (eg, Lewy body dementia, Parkinson’s disease, narcolepsy). The researchers reported that eight of the patients (57%) found melatonin treatment successful in reducing or alleviating the symptoms of REM-sleep behavior disorder for a year or more. In two patients, melatonin was ineffective; one of these experienced an increase in both the frequency and severity of REM-sleep behavior disorder. However, the researchers noted, only five patients (36%) experienced infrequent adverse effects such as headaches or morning somnolence, all of which stopped when the melatonin dose was reduced. The investigators called for a prospective, double-blind, placebo-controlled study of melatonin use in patients with REM-sleep behavior disorder before advocating widespread usage.

Patients with seizures, both epileptic and nonepileptic, should keep their dentist informed of their condition, advised doctors in a report in the July/August General Dentistry. Some drugs commonly used in dentistry could induce seizure activity in patients with epilepsy, the authors noted. Additionally, anti-seizure drugs often have adverse effects that can cause oral health problems or complicate dental procedures. These include increased incidence of infection, xerostomia, gingival hypertrophy, delayed healing, bleeding gums, and postoperative bleeding. Patients with seizures are urged to visit their dentist frequently, as such adverse effects require careful attention to dental hygiene.

A single injection of a small-molecule death-associated protein kinase (DAPK) inhibitor given up to six hours after brain injury or stroke protects against additional brain cell death for a week or longer, according to researchers at Northwestern University in Chicago. “Results of this study support the idea that targeting protein kinases [such as DAPK], which function early in programmed cell death pathways, could identify new therapeutic approaches to acute brain injury,” the researchers said. While initial results with the DAPK inhibitor revealed that the compound lacked desirable molecular properties for drug development, the recent study, published in the September online issue of Bioorganic and Medicinal Chemistry Letters, isolated a candidate DAPK inhibitor that researchers believe will allow them to create analog inhibitors with more desirable molecular properties.

An international research team has identified a gene responsible for Lafora disease. The finding was reported in the September Nature Genetics. In 1998, investigators identified a first gene implicated in Lafora disease, called EPM2A. However, it explained the underlying problem in only 50% of Lafora disease families, the investigators noted. The newly discovered gene, NHLRC1, produces a protein thought to be involved in marking other proteins for cellular destruction. Early data suggested that both genes work in tandem to safeguard neurons against accumulating excess carbohydrates; if either gene is missing, the result is epilepsy, the researchers said. “Importantly, we can now explain Lafora disease in 90% of families, and for the remaining 10%, we think there is a third yet-to-be-identified disease gene,” they noted.

MRI may have use in identifying remyelinated lesions in multiple sclerosis (MS), according to a study published in the August Archives of Neurology. In a comparison of postmortem MRI findings with histopathologic findings, MRI images from 36 rapid autopsies yielded 161 areas that could be matched with histologic characteristics, including 149 focal T2-weighted abnormalities. An observer blinded to the MRI findings assessed the presence of remyelination using light microscopic criteria. The researchers reported that remyelinated areas were found in 67 lesions (42%). All areas of remyelination returned abnormal signals on T2-weighted images. Both T1 images and magnetization transfer ratio may have limited additional value in separating lesions without remyelination, the investigators noted.

Researchers delivered modified dystrophin proteins to the heart of a mouse with Duchenne muscular dystrophy. The study was the first viral-mediated cardiac gene therapy study, and also the first to focus on cardiac muscle instead of skeletal muscle. Researchers used recombinant adeno-associated virus to deliver a micro-dystrophin gene, and 10 months after the therapy found that the micro-dystrophin expression in the heart can correct several biochemical and cellular defects in the dystrophic mouse heart. The results were published in the September Circulation.

Animal studies point to a possible link between trace amounts of copper and the amyloid plaques typical of Alzheimer’s disease. Researchers observed that rabbits fed a high-cholesterol diet that drank distilled water developed fewer plaques than those on the same diet that drank tap water. After finding significant amounts of copper present in the tap water, the researchers added trace amounts of the element to the distilled water of some of the cholesterol-fed rabbits. They found that the animals drinking the cupric water developed significantly more plaques and plaque precursors than the rabbits drinking the unaltered distilled water. The results were published in the August 14 online publication of the Proceedings of the National Academy of Sciences.

Meningitis occurs when blood-borne pathogens cross the blood-brain barrier. In the September Journal of Clinical Investigation, researchers reported that human meningeal pathogen (group B Streptococcus) infection “induced a highly specific and coordinate set of genes known to orchestrate neutrophil recruitment, activation, and enhanced survival,” in the blood-brain barrier. The study, conducted using allelic exchange techniques, will aid in understanding how the blood-brain barrier responds to infectious diseases and may point to a therapeutic target, the researchers said.

Transfused red blood cells, platelets, and fresh-frozen plasma can transmit West Nile virus, according to a report in the September 18 New England Journal of Medicine. Twenty-three patients were confirmed to have acquired West Nile virus through transfused leukoreduced and nonleukoreduced red cells, platelets, or fresh-frozen plasma. Of the 23 recipients, 10 were immunocompromised owing to transplantation or cancer; eight were 70 or older. Sixteen donors with evidence of viremia were linked to the infected recipients. Nine of these donors reported viral symptoms before or after donation, five were asymptomatic, and two were lost to follow-up. All 16 donors were negative for West Nile virus–specific IgM antibody at donation.

Having diabetes along with hypertension raises the risk of silent cerebral infarcts. Researchers performed MRI scans and 24-hour blood pressure monitoring on 360 Japanese patients (134 men) with nonsymptomatic hypertension. Of these men, 159 had comorbid diabetes. None of the patients had been diagnosed with other cardiovascular diseases. The researchers reported in the September 19 rapid-access issue of Stroke that evidence of silent cerebral infarcts was detected in 82% of patients with diabetes and hypertension and in 58% of patients with hypertension alone. Three or more silent cerebral infarcts were found in 62% of patients with both diseases, and in 35% of those with hypertension alone. Participants were significantly more likely to have one or more silent cerebral infarcts if they were male, were older, had diabetes, had higher systolic blood pressure, or had hypertension for 10 or more years.

Eating fruits and green or yellow vegetables daily may protect against hemorrhagic and ischemic stroke, according to a report in the September 19 rapid-access Stroke. A subset of participants in the Life Span Study in Japan (14,966 men, average age 54, and 23,471 women, average age 58) rated their consumption of green or yellow vegetables and fruits as part of a lifestyle and dietary questionnaire. During an 18-year follow-up, researchers determined that 1,926 participants died of stroke. Almost daily consumption of green or yellow vegetables reduced the risk of death from stroke by 26% in both men and women, compared with those who ate vegetables no more than once per week. Almost daily fruit intake reduced the risk of stroke death by 35% in men and 25% in women. Frequent fruit and vegetable intake also protected against death from cerebral infarction and intracerebral hemorrhage in both men and women.

NR

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